异丙酚靶控输注镇静时脑电双频指数和非线性参数变化分析  

Analysis of the bispectral index (BIS) and the EEG nonlinear index during the sedation by the target-controlled infusion of propofol

作　　者：欧阳铭文[1] 吴东宇[2] 张宏[1] 

机构地区：[1]解放军总医院麻醉科,北京100853 [2]解放军总医院神经信息中心,北京100853

出　　处：《解放军医学杂志》2006年第6期597-598,共2页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金资助课题(30340075)

摘　　要：目的分析异丙酚靶控输注(TCI)时意识消失-清醒时的脑电双频指数(BIS)和非线性参数关联维数(D2)、近似熵(ApEn)、复杂度(Cx)的变化。方法ASAⅠ～Ⅱ级择期行下肢手术患者20例,血药浓度(Cp)为目标TCI,0.3～0.5μg/ml浓度梯度上下调整Cp予术中镇静,直至患者意识消失,每个预期浓度维持12min,记录患者意识清醒-消失时的脑电BIS值和非线性参数。结果意识消失-清醒时,BIS值分别为67.3±7.9,80.2±6.2;D2值分别为3.01±0.16,3.45±0.18;ApEn值分别为0.71±0.060.84±0.05;Cx值分别为0.44±0.05,0.55±0.05。在意识消失时的脑电确定性阈值(定义为100%特异度)BIS为51(灵敏度3.8%)D2为2.90(灵敏度30.3%),ApEn为0.69(灵敏度42.3%),Cx为0.41(灵敏度25.5%)。结论BIS、D2、ApEn及Cx均可反映异丙酚镇静时意识消失清醒的变化,提示四个值中ApEn是区分意识清醒-消失的最佳指标。Objective To analyze the bispectral index （BIS） and the EEG nonlinear index （including Correlation dimension, D2; Approximate entropy, ApEn; Complexity, Cx. ） during alternating periods of consciousness and unconsciousness produced by target--controlled infusions （TCI） of propofol. Methods We studied twenty patients （ASA Ⅰ-Ⅱ grades） undergoing the elected leg operations under epidural anesthesia. With TCI consciousness of the patient was controlled by an increase or decrease of concentration of propofol in a range of 0. 3-0. 5μg/ml for four times. Every target plasma concentration of propofol lasted 12 minutes. BIS, D2, ApEn and Cx were recorded simultaneously during the periods of consciousness and unconsciousness every 3 minutes. Results During consciousness and unconsciousness, the respective mean values for the four measurements were： BIS, 80. 2±6. 2 and 67. 3±7. 9; D2, 3. 45±0. 18 and 3. 01±0. 16; ApEn, 0. 84±0. 05 and 0. 71±0.06; Cx, 0. 55±0. 05 and 0. 44±0. 05. Determined threshold values with 100% specificity during the state of were： BIS, 51 （sensitivity3. 8%）; D2, 2. 90 （sensitivity 30. 3%）; ApEn, 0. 69 （sensitivity42. 3%）; Cx, 0. 41 （sensitivity 25. 5%）. Conclusion BIS, D2, ApEn and Cx can all reflect the change in consciousness and unconsciousness produced by TCI of propofol. Our findings suggest that of the four EEG variables, ApEn was best in identifying the transition from unconsciousness to consciousness.

关 键 词：二异丙酚 靶控输注 清醒镇静 双频指数 脑电非线性参数 

分 类 号：R614[医药卫生—麻醉学]